| Title: |
Discontinuation of anti-tumour necrosis factor alpha treatment owing to blood test abnormalities, and cost-effectiveness of alternate blood monitoring strategies |
| Authors: |
Abhishek, Abhishek; Stevenson, Matthew D; Nakafero, Georgina; Grainge, Matthew J; Evans, Ian; Alabas, Oras; Card, Tim; Taal, Maarten W; Aithal, Guruprasad P; Fox, Christopher P; Mallen, Christian D; van der Windt, Danielle A; Riley, Richard D; Warren, Richard B; Williams, Hywel C |
| Source: |
Abhishek, A, Stevenson, M D, Nakafero, G, Grainge, M J, Evans, I, Alabas, O, Card, T, Taal, M W, Aithal, G P, Fox, C P, Mallen, C D, van der Windt, D A, Riley, R D, Warren, R B & Williams, H C 2024, 'Discontinuation of anti-tumour necrosis factor alpha treatment owing to blood test abnormalities, and cost-effectiveness of alternate blood monitoring strategies', The British journal of dermatology, vol. 190, no. 4, ljad430, pp. 559-564. https://doi.org/10.1093/bjd/ljad430, https://doi.org/10.1093/bjd/ljad430 |
| Publication Year: |
2024 |
| Collection: |
The University of Manchester: Research Explorer - Publications |
| Subject Terms: |
Adult; Cost-Benefit Analysis; Female; Hematologic Tests; Humans; Male; Necrosis; Quality-Adjusted Life Years; Retrospective Studies; Tumor Necrosis Factor-alpha |
| Description: |
BACKGROUND: There is no evidence base supporting the use of six-monthly monitoring blood tests for the early detection of liver, blood, and renal toxicity during established anti-TNF-alpha treatment. OBJECTIVES: To evaluate the incidence and risk factors of anti-TNF-alpha treatment cessation due to liver, blood, and renal side-effects and, to estimate the cost-effectiveness of alternate intervals between monitoring blood tests. METHODS: A secondary-care based retrospective cohort study was performed. Data from the British Association of Dermatologists Biologic and Immunomodulators Register were used. Patients with at-least moderate psoriasis prescribed their first anti-TNF-alpha treatment were included. Treatment discontinuation due to monitoring blood test abnormality was the primary-outcome.Patients were followed-up from treatment start to the earliest of outcome, drug-discontinuation, death, five years, or 31/07/2021. The incidence rate and 95% confidence intervals (CIs) of anti-TNF-alpha discontinuation with monitoring blood test abnormality was calculated. Multivariate Cox regression was used to examine the association between risk-factors and outcome. A mathematical model evaluated costs and quality-adjusted life years (QALYs) associated with lengthening the time between monitoring blood tests during anti-TNF-alpha treatment. RESULTS: The cohort included 8,819 participants (3,710 (42.1%) female, mean age (standard deviation) 44.76 (13.20) years) that contributed 25,058 person-years of follow-up and experienced 125 treatment discontinuations due to monitoring blood test abnormality at an incidence rate (95%CI) of 5.85 (4.91-6.97)/1,000 person-years. Of these, 64, and 61 discontinuations occurred within the first year, and after the first-year of treatment start at an incidence rate (95% CI) of 8.62 (6.74-11.01) and 3.44 (2.67-4.42)/1000 person-years respectively. Increasing age in years, diabetes, and liver disease associated with anti-TNF-alpha discontinuation with monitoring blood test abnormality with ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| ISSN: |
0007-0963; 1365-2133 |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/37931161; info:eu-repo/semantics/altIdentifier/wos/001143222300001; info:eu-repo/semantics/altIdentifier/pissn/0007-0963; info:eu-repo/semantics/altIdentifier/eissn/1365-2133 |
| DOI: |
10.1093/bjd/ljad430 |
| Availability: |
https://research.manchester.ac.uk/en/publications/02e38be4-d09b-41a3-904c-cf44e36d49b7; https://doi.org/10.1093/bjd/ljad430; https://www.mendeley.com/catalogue/f6fd9503-ae7d-34e7-a8dd-8019d9cb76e3/; https://www.scopus.com/pages/publications/85187962446 |
| Rights: |
info:eu-repo/semantics/openAccess ; http://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.FAD4F120 |
| Database: |
BASE |